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Skin Cancer 2019: Reflectance Confocal Microscopy Plus Optical Coherence Tomography in Diagnosing Suspicious Basal Cell Carcinoma Lesions

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Key Points

  • Higher sensitivity and negative predictive value, comparable specificity, and positive predictive value were observed for the combined RCM-OCT device for diagnosis of all lesions.
  • Relatively higher specificity and positive predictive value were observed in clinically suspicious lesions.
  • A high correlation was observed between the OCT-predicted depth and histopathologically measured depth.

The increasing incidence and prevalence of nonmelanoma skin cancers has led to the search for new and more efficient diagnostic imaging and therapy guidance approaches. However, proper selection of therapy requires the precise delineation of skin cancer margins. To address this need, researchers combined reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) within the same instrument to achieve comprehensive three-dimensional skin imaging in vivo. Findings on this screening strategy were presented by Iftimia et al at the World Congress on Advanced Treatments and Technologies in Skin Cancer (Skin Cancer 2019) (Poster Board 4).

According to a report by Batta et al in MDedge, RCM allows “dermatologists [to] view horizontal sections in a resolution comparable to histology, observe dynamic processes in living skin, and monitor lesion evolution longitudinally.” And a report in Neoplasia by Fujimoto et al describes OCT as “an emerging technology for performing high-resolution cross-sectional imaging. OCT is analogous to ultrasound imaging, except that it uses light instead of sound.”

Methods and Findings

The clinical study included 85 patients with either clinically suspicious (n = 60, in intact skin) or biopsy-proven basal cell carcinomas (n = 25, in scarred skin). Researchers correlated basal cell carcinoma features in RCM and OCT images with histopathology and calculated diagnostic accuracy. They correlated the depth predicted by OCT with histopathologically measured depth.

Higher sensitivity and negative predictive value (100%), comparable specificity (48% vs 56% on RCM), and positive predictive value (82.19 vs 84.59 % on RCM) were observed for the combined RCM-OCT device for the diagnosis of all lesions. Relatively higher specificity (94.1%) and positive predictive value (75%) were observed in the clinically suspicious lesions. High correlation was observed between the OCT-predicted depth and histopathologically measured depth.

The authors concluded that RCM-OCT imaging may be prospectively used to comprehensively diagnose suspicious basal cell carcinoma lesions, determine subtype, and triage for treatment.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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